Application for Citizen Advisory Committee

Citizen Advisory Committee, Commission, or Board
Please complete the application online and submit it. If you wish to request a paper application, you may do so by calling Phil Chapman at 218 726-2385, or by sending an e-mail to him at: chapmanp@stlouiscountymn.gov Paper applications should be returned to the following address: Clerk of the County Board, 100 N. 5th Avenue West, #214, Duluth, MN 55802-1293.

Printable copy (PDF)
Application
Application For:
Please list the committee, commission, or board for which you are applying
Applicant Name

First Name
Last Name
Email

Address

Phone
Area CodePhone Number
How long have you lived in St. Louis County?
List other community groups, boards, committees, or commissions for which you are, or have been a member.
What interests you about becoming a member of the committee, commission or board for which you are applying?
Please describe your education, employment, areas of interest, and expertise.
Please provide additional information you believe is important in considering your application.
Please list two references including name, address, and telephone number.
I have sufficient time to devote to this responsibility and will attend the required meetings if appointed.
Date
Month - Day - Year
Captcha
THANK YOU!
______________________________________________

Office Use Only

Date Received __________ Appointment Date __________

Date Entered __________ Term End Date ___________

Commissioner District __________ Retention Date __________

Appointed: Yes _____ No _____

Committee/Board/Commission: ________________________________

Application